Fever of unknown origin approach US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Fever of unknown origin approach. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Fever of unknown origin approach US Medical PG Question 1: A scientist in Chicago is studying a new blood test to detect Ab to EBV with increased sensitivity and specificity. So far, her best attempt at creating such an exam reached 82% sensitivity and 88% specificity. She is hoping to increase these numbers by at least 2 percent for each value. After several years of work, she believes that she has actually managed to reach a sensitivity and specificity much greater than what she had originally hoped for. She travels to China to begin testing her newest blood test. She finds 2,000 patients who are willing to participate in her study. Of the 2,000 patients, 1,200 of them are known to be infected with EBV. The scientist tests these 1,200 patients' blood and finds that only 120 of them tested negative with her new exam. Of the patients who are known to be EBV-free, only 20 of them tested positive. Given these results, which of the following correlates with the exam's specificity?
- A. 82%
- B. 90%
- C. 84%
- D. 86%
- E. 98% (Correct Answer)
Fever of unknown origin approach Explanation: ***98%***
- **Specificity** measures the proportion of **true negatives** among all actual negatives.
- In this case, 800 patients are known to be EBV-free (actual negatives), and 20 of them tested positive (false positives). This means 800 - 20 = 780 tested negative (true negatives). Specificity = (780 / 800) * 100% = **98%**.
*82%*
- This value represents the *original sensitivity* before the scientist’s new attempts to improve the test.
- It does not reflect the *newly calculated specificity* based on the provided data.
*90%*
- This value represents the *newly calculated sensitivity* of the test, not the specificity.
- Out of 1200 EBV-infected patients, 120 tested negative (false negatives), meaning 1080 tested positive (true positives). Sensitivity = (1080 / 1200) * 100% = 90%.
*84%*
- This percentage is not directly derived from the information given for either sensitivity or specificity after the new test results.
- It does not correspond to any of the calculated values for the new test's performance.
*86%*
- This percentage is not directly derived from the information given for either sensitivity or specificity after the new test results.
- It does not correspond to any of the calculated values for the new test's performance.
Fever of unknown origin approach US Medical PG Question 2: A 3-year-old patient is brought to the emergency department by her mother due to inability to walk. The child has been limping recently and as of this morning, has refused to walk. Any attempts to make the child walk or bear weight result in crying. She was recently treated for impetigo and currently takes a vitamin D supplement. Physical exam is remarkable for an anxious appearing toddler with knee swelling, erythema, and limited range of motion due to pain. Her mother denies any recent trauma to the child's affected knee. Temperature is 103°F (39.4°C), pulse is 132/min, blood pressure is 90/50 mmHg, respirations are 18/min, and oxygen saturation is 99% on room air. Which of the following is the best initial step in management?
- A. MRI
- B. Ultrasound
- C. Synovial fluid analysis (Correct Answer)
- D. Broad spectrum antibiotics
- E. Radiograph
Fever of unknown origin approach Explanation: ***Synovial fluid analysis***
- The patient's presentation with **fever**, **joint pain**, inability to bear weight, and **swelling/erythema** of the knee is highly suggestive of **septic arthritis**.
- **Arthrocentesis** and subsequent **synovial fluid analysis** (cell count with differential, Gram stain, culture) is the definitive diagnostic test to confirm septic arthritis and identify the causative organism.
*MRI*
- While MRI can visualize soft tissue and bone, it is generally reserved for cases where the diagnosis is unclear or to evaluate for complications such as **osteomyelitis** or abscess formation, after initial diagnostic steps.
- It is not the **initial diagnostic step** for suspected septic arthritis, which requires prompt identification of the pathogen to guide antibiotic therapy.
*Ultrasound*
- **Ultrasound** can identify joint effusion, but it cannot differentiate between septic arthritis and other causes of joint effusion.
- It may be used to guide arthrocentesis if the effusion is difficult to aspirate.
*Broad spectrum antibiotics*
- Although **broad-spectrum antibiotics** are indicated for **presumed septic arthritis**, they should be administered *after* obtaining fluid for culture.
- Starting antibiotics before collecting cultures can lead to **false-negative culture results**, hindering identification of the causative organism and appropriate antibiotic selection.
*Radiograph*
- **Radiographs** can rule out fracture or dislocation and may show signs of soft tissue swelling or effusion, but they are not sensitive enough to diagnose early septic arthritis.
- They also cannot differentiate septic arthritis from other inflammatory arthropathies or sterile effusions.
Fever of unknown origin approach US Medical PG Question 3: A 15-year-old boy is brought to the Emergency department by ambulance from school. He started the day with some body aches and joint pain but then had several episodes of vomiting and started complaining of a terrible headache. The school nurse called for emergency services. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. Past medical history is noncontributory. He is a good student and enjoys sports. At the hospital, his blood pressure is 120/80 mm Hg, heart rate is 105/min, respiratory rate is 21/min, and his temperature is 38.9°C (102.0°F). On physical exam, he appears drowsy with neck stiffness and sensitivity to light. Kernig’s sign is positive. An ophthalmic exam is performed followed by a lumbar puncture. An aliquot of cerebrospinal fluid is sent to microbiology. A gram stain shows gram-negative diplococci. A smear is prepared on blood agar and grows round, smooth, convex colonies with clearly defined edges. Which of the following would identify the described pathogen?
- A. Oxidase-positive and ferments glucose and maltose (Correct Answer)
- B. Oxidase-positive test and ferments glucose only
- C. Catalase-negative and oxidase-positive
- D. No growth on Thayer-Martin medium
- E. Growth in anaerobic conditions
Fever of unknown origin approach Explanation: ***Oxidase-positive and ferments glucose and maltose***
- The patient's symptoms (fever, headache, neck stiffness, sensitivity to light, positive Kernig's sign) are classic for **meningitis**, and the CSF showing **gram-negative diplococci** points to *Neisseria meningitidis*.
- *Neisseria meningitidis* is identified by its positive **oxidase test** and its ability to ferment both **glucose and maltose**.
*Oxidase-positive test and ferments glucose only*
- This description corresponds to *Neisseria gonorrhoeae*, which primarily causes **gonorrhea** and occasionally meningitis due to disseminated infection but is less common in this age group and presentation.
- While *Neisseria gonorrhoeae* is also an **oxidase-positive gram-negative diplococcus**, it specifically ferments only *glucose*, not maltose.
*Catalase-negative and oxidase-positive*
- While *Neisseria meningitidis* is **oxidase-positive**, stating it is "catalase-negative" is incorrect; *Neisseria* species are actually **catalase-positive**.
- This option incorrectly describes a general metabolic property that would rule out *Neisseria meningitidis*.
*No growth on Thayer-Martin medium*
- Thayer-Martin medium is a **selective medium** specifically designed to isolate pathogenic *Neisseria species* by inhibiting the growth of commensal bacteria and fungi.
- Therefore, *Neisseria meningitidis* would **grow well** on Thayer-Martin medium, making "no growth" an incorrect identifier.
*Growth in anaerobic conditions*
- *Neisseria meningitidis* is an **obligate aerobe**, meaning it requires oxygen for growth.
- It would **not grow** in anaerobic conditions, making this statement false for identifying the described pathogen.
Fever of unknown origin approach US Medical PG Question 4: A 38-year-old woman comes to the physician because of a 4-day history of swelling and pain in her left knee. She has had similar episodes of swollen joints over the past 3 weeks. Two months ago, she had a rash on her upper back that subsided after a few days. She lives in Pennsylvania and works as a forest ranger. Her temperature is 37.8°C (100°F). Physical examination shows a tender and warm left knee. Arthrocentesis of the knee joint yields cloudy fluid with a leukocyte count of 65,000/mm3 and 80% neutrophils. A Gram stain of synovial fluid does not show any organisms. Which of the following is the most likely cause of this patient's condition?
- A. Production of autoantibodies against Fc portion of IgG
- B. Wearing down of articular cartilage
- C. Postinfectious activation of innate lymphoid cells of the gut
- D. Infection with spiral-shaped bacteria (Correct Answer)
- E. Infection with round bacteria in clusters
Fever of unknown origin approach Explanation: ***Infection with spiral-shaped bacteria***
- This clinical presentation, including multifocal arthritis following a rash, a mild fever, and a history of working as a forest ranger in Pennsylvania (an **endemic area**), is highly suggestive of **Lyme arthritis**.
- Lyme disease is caused by the **spirochete** *Borrelia burgdorferi*, a **spiral-shaped bacterium**, transmitted by tick bites.
*Production of autoantibodies against Fc portion of IgG*
- This describes the presence of **rheumatoid factor (RF)**, which is characteristic of **rheumatoid arthritis (RA)**.
- RA typically presents with chronic, symmetrical polyarthritis, often involving the small joints, and does not commonly begin with an acute rash or affect forest rangers specifically.
*Wearing down of articular cartilage*
- This mechanism is characteristic of **osteoarthritis (OA)**, which is a degenerative joint disease.
- OA typically affects older individuals, is not associated with acute inflammatory episodes, fevers, or the presence of a rash, and the synovial fluid analysis would show fewer inflammatory cells.
*Postinfectious activation of innate lymphoid cells of the gut*
- This mechanism is associated with **reactive arthritis** or spondyloarthropathies, which are typically triggered by gastrointestinal or genitourinary infections.
- While reactive arthritis can cause acute arthritis, the prodromal rash, geographic location, and specific sequence of symptoms point away from a gut-derived trigger.
*Infection with round bacteria in clusters*
- **Round bacteria in clusters** (Gram-positive cocci in clusters) typically refers to **Staphylococcus aureus**, a common cause of **septic arthritis**.
- While septic arthritis can cause acute, painful, swollen joints with high synovial fluid leukocyte counts, the history of a preceding rash and multifocal, migratory joint involvement makes Lyme arthritis more likely; also, a Gram stain for *Staphylococcus* would typically be positive.
Fever of unknown origin approach US Medical PG Question 5: A 2-year-old boy presents for a routine checkup. The patient’s mother says that he has been ‘under the weather’ for the past few days. She did not measure his temperature at home but states that he has felt warm. She denies any episodes of diarrhea or vomiting. No significant past medical history or current medications. The patient attends daycare. He is due for a hepatitis A vaccine. The patient was born at term with no prenatal or perinatal complications. The vital signs include: temperature 37.8°C (100.1°F), blood pressure 112/62 mm Hg, pulse 80/min, respiratory rate 18/min, and oxygen saturation 99% on room air. The patient is alert and responsive. The physical exam is unremarkable. Which of the following is the most appropriate next step in the management of this patient?
- A. Order a complete blood count
- B. Order liver function tests
- C. Strep rapid antigen detection test
- D. Administer the hepatitis A vaccine (Correct Answer)
- E. Delay the hepatitis A immunization until next visit
Fever of unknown origin approach Explanation: ***Administer the hepatitis A vaccine***
- The patient has a **low-grade fever** (37.8°C), which is generally **not considered a contraindication** for vaccination, especially if the child is otherwise well and active.
- The patient's presentation of being "under the weather" with an unremarkable physical exam and stable vitals suggests a **mild illness**, allowing for routine vaccinations to proceed.
*Order a complete blood count*
- A **CBC is not indicated** at this time, as the patient displays only mild, non-specific symptoms and has a normal physical exam.
- This would be reserved for cases with more concerning signs of infection or systemic illness, such as persistent high fever, lethargy, or specific clinical findings.
*Order liver function tests*
- **Liver function tests are not warranted** as the patient has no symptoms or signs suggestive of liver disease (e.g., jaundice, right upper quadrant pain, dark urine).
- While the patient is due for a hepatitis A vaccine, there is no clinical evidence of active hepatitis or liver dysfunction requiring diagnostic workup.
*Strep rapid antigen detection test*
- The patient has **no symptoms consistent with streptococcal pharyngitis**, such as sore throat, tonsillar exudates, or cervical lymphadenopathy.
- Given the lack of specific symptoms, testing for strep throat would be inappropriate and potentially lead to unnecessary antibiotic use.
*Delay the hepatitis A immunization until next visit*
- Delaying vaccination is only recommended for **moderate to severe acute illnesses** with or without fever, or for certain contraindications.
- A mild illness with low-grade fever, as in this case, is generally **not a reason to postpone** routine immunizations, as per CDC guidelines.
Fever of unknown origin approach US Medical PG Question 6: A 13-year-old girl is brought to the physician because of worsening fever, headache, photophobia, and nausea for 2 days. One week ago, she returned from summer camp. She has received all age-appropriate immunizations. Her temperature is 39.1°C (102.3°F). She is oriented to person, place, and time. Physical examination shows a maculopapular rash. There is rigidity of the neck; forced flexion of the neck results in involuntary flexion of the knees and hips. Cerebrospinal fluid studies show:
Opening pressure 120 mm H2O
Appearance Clear
Protein 47 mg/dL
Glucose 68 mg/dL
White cell count 280/mm3
Segmented neutrophils 15%
Lymphocytes 85%
Which of the following is the most likely causal organism?
- A. Echovirus (Correct Answer)
- B. Listeria monocytogenes
- C. Streptococcus pneumoniae
- D. Herpes simplex virus
- E. Neisseria meningitidis
Fever of unknown origin approach Explanation: ***Echovirus***
- The patient's symptoms (fever, headache, photophobia, maculopapular rash, neck rigidity) along with CSF findings of **lymphocytic pleocytosis**, **normal glucose**, and **moderately elevated protein** are highly suggestive of **aseptic meningitis**.
- **Enteroviruses**, such as Echovirus, are the most common cause of **viral (aseptic) meningitis**, especially in children and during summer months, fitting the patient's age and recent summer camp attendance.
*Listeria monocytogenes*
- This organism typically causes meningitis in **neonates, elderly, or immunocompromised individuals**, which does not fit this healthy 13-year-old girl.
- While it can cause lymphocytic pleocytosis, it is less likely given the patient's age and presentation.
*Streptococcus pneumoniae*
- This is a common cause of **bacterial meningitis**, characterized by **PMN predominance (neutrophilic pleocytosis)**, **low CSF glucose**, and **markedly elevated CSF protein**, which are not seen in this case.
- The patient is also described as having received all age-appropriate immunizations, likely including the pneumococcal vaccine.
*Herpes simplex virus*
- HSV can cause aseptic meningitis or encephalitis, but it often presents with **focal neurological deficits** or **seizures** in cases of encephalitis, which are absent here.
- While it can cause lymphocytic pleocytosis, the maculopapular rash is less typical for HSV meningitis compared to enteroviruses.
*Neisseria meningitidis*
- This typically causes **bacterial meningitis** with characteristic CSF findings of **neutrophilic pleocytosis**, **low glucose**, and **high protein**.
- Although it can cause a rash (petechial or purpuric), the CSF profile and absence of petechiae make bacterial meningitis less likely.
Fever of unknown origin approach US Medical PG Question 7: Five days after being admitted to the hospital for a scald wound, a 2-year-old boy is found to have a temperature of 40.2°C (104.4°F). He does not have difficulty breathing, cough, or painful urination. He initially presented one hour after spilling a pot of boiling water on his torso while his mother was cooking dinner. He was admitted for fluid resuscitation, nutritional support, pain management, and wound care, and he was progressing well until today. He has no other medical conditions. Other than analgesia during this hospital stay, he does not take any medications. He appears uncomfortable but not in acute distress. His pulse is 150/min, respirations are 41/min, and blood pressure is 90/50 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 99%. Examination shows uneven, asymmetrical scalding covering his anterior torso in arrow-like patterns with surrounding erythema and purulent discharge. The remainder of the examination shows no abnormalities. His hemoglobin is 13.4 g/dL, platelet count is 200,000/mm3, and leukocyte count is 13,900/mm3. Which of the following is the most appropriate initial pharmacological treatment for this patient?
- A. Vancomycin and metronidazole
- B. Amoxicillin/clavulanic acid and ceftriaxone
- C. Ampicillin/sulbactam and daptomycin
- D. Vancomycin and cefepime (Correct Answer)
- E. Piperacillin/tazobactam and cefepime
Fever of unknown origin approach Explanation: ***Vancomycin and cefepime***
- The patient presents with classic signs of **burn wound infection**, including fever, purulent discharge, and a rapid pulse, necessitating broad-spectrum antibiotic coverage.
- **Vancomycin** provides excellent coverage against **MRSA (methicillin-resistant *Staphylococcus aureus*)**, a common pathogen in burn infections, while **cefepime** covers **gram-negative bacteria**, including *Pseudomonas aeruginosa*, which is also frequently implicated.
*Vancomycin and metronidazole*
- While vancomycin covers gram-positive bacteria like **MRSA**, **metronidazole** primarily targets **anaerobic bacteria**, which are less common as primary pathogens in burn wound infections.
- This combination lacks adequate coverage for crucial gram-negative bacteria such as *Pseudomonas aeruginosa*.
*Amoxicillin/clavulanic acid and ceftriaxone*
- This combination provides coverage against some common community-acquired pathogens but is insufficient for the broad-spectrum needs of a severe **hospital-acquired burn infection**.
- It lacks reliable coverage for **MRSA** and *Pseudomonas aeruginosa*, which are critical in this setting.
*Ampicillin/sulbactam and daptomycin*
- **Ampicillin/sulbactam** covers some gram-positive and gram-negative bacteria but would not reliably cover **MRSA** or *Pseudomonas aeruginosa*.
- **Daptomycin** is effective against gram-positive bacteria, including **MRSA**, but does not cover gram-negative pathogens, leaving a significant gap in treatment.
*Piperacillin/tazobactam and cefepime*
- Both **piperacillin/tazobactam** and **cefepime** are excellent broad-spectrum antibiotics covering gram-negative pathogens, including *Pseudomonas aeruginosa*, but are largely redundant in this combination.
- This regimen lacks specific coverage for **MRSA**, which is a significant concern in nosocomial burn wound infections.
Fever of unknown origin approach US Medical PG Question 8: A 5-year-old boy presents to your office with his mother. The boy has been complaining of a sore throat and headache for the past 2 days. His mother states that he had a fever of 39.3°C (102.7°F) and had difficulty eating. On examination, the patient has cervical lymphadenopathy and erythematous tonsils with exudates. A streptococcal rapid antigen detection test is negative. Which of the following is the most likely causative agent?
- A. A gram-negative, pleomorphic, obligate intracellular bacteria
- B. An enveloped, single-stranded, negative sense RNA virus
- C. A gram-positive, beta-hemolytic cocci in chains
- D. An enveloped, double-stranded DNA virus (Correct Answer)
- E. A naked, double-stranded DNA virus
Fever of unknown origin approach Explanation: ***An enveloped, double-stranded DNA virus***
- This description refers to **Epstein-Barr virus (EBV)**, which is a common cause of **infectious mononucleosis** in children and adolescents.
- Symptoms like **sore throat**, **fever**, **fatigue**, **cervical lymphadenopathy**, and **erythematous tonsils with exudates** are classic for mononucleosis; a negative strep test helps rule out bacterial pharyngitis.
*A gram-negative, pleomorphic, obligate intracellular bacteria*
- This describes organisms like **Chlamydia** or **Rickettsia**, which typically cause different sets of symptoms, such as sexually transmitted infections or tick-borne diseases.
- These are **not common causes of pharyngitis** with exudates and cervical lymphadenopathy in children.
*An enveloped, single-stranded, negative sense RNA virus*
- This describes viruses such as **influenza virus** or **respiratory syncytial virus (RSV)**.
- While these can cause pharyngitis, the overall clinical picture, particularly the prominent **lymphadenopathy** and **exudative tonsillitis** in the presence of a negative strep test, is less typical for these viruses compared to EBV.
*A gram-positive, beta-hemolytic cocci in chains*
- This describes **Group A Streptococcus (GAS)**, which is the causative agent of **streptococcal pharyngitis (strep throat)**.
- Although the symptoms are consistent with strep throat, the information states that the **rapid antigen detection test for streptococcus was negative**, making this diagnosis highly unlikely.
*A naked, double-stranded DNA virus*
- This describes viruses such as **adenoviruses** or **human papillomaviruses**.
- While adenoviruses can cause pharyngitis, the detailed clinical presentation of **prominent exudative tonsillitis** and **cervical lymphadenopathy** in the context of a negative strep test points more strongly to infectious mononucleosis caused by EBV.
Fever of unknown origin approach US Medical PG Question 9: A 12-year-old boy is brought in by his mother to the emergency department. He has had abdominal pain, fever, nausea, vomiting, and loss of appetite since yesterday. At first, the mother believed it was just a "stomach flu," but she is growing concerned about his progressive decline. Vitals include: T 102.3 F, HR 110 bpm, BP 120/89 mmHg, RR 16, O2 Sat 100%. Abdominal exam is notable for pain over the right lower quadrant. What is the next best step in management in addition to IV hydration and analgesia?
- A. Upright and supine abdominal radiographs
- B. Abdominal MRI with gadolinium contrast
- C. Abdominal CT scan with IV contrast
- D. Right lower quadrant ultrasound (Correct Answer)
- E. Abdominal CT scan with IV and PO contrast
Fever of unknown origin approach Explanation: ***Right lower quadrant ultrasound***
- In a 12-year-old boy with suspected **appendicitis**, **ultrasound** is the preferred initial imaging modality due to its **lack of radiation** and high diagnostic accuracy in this population.
- It effectively identifies an inflamed **appendix**, periappendiceal fluid, and other relevant findings while avoiding radiation exposure, which is particularly important in children.
*Upright and supine abdominal radiographs*
- **Plain abdominal X-rays** are generally not useful for diagnosing appendicitis as they often do not visualize the appendix directly.
- While they can rule out other causes of abdominal pain like **bowel obstruction** or **perforation** (free air), they lack the sensitivity and specificity for appendicitis.
*Abdominal MRI with gadolinium contrast*
- **MRI** is an excellent alternative to CT, especially in pregnant patients, but it is **less readily available** and consumes more time than ultrasound in an emergent setting for a pediatric patient.
- Though it provides good soft tissue detail without radiation, its **cost and accessibility** make it less practical as a first-line imaging test for suspected appendicitis in children.
*Abdominal CT scan with IV contrast*
- An **abdominal CT scan with IV contrast** is highly accurate for diagnosing appendicitis, but it involves significant **ionizing radiation**, which should be minimized in pediatric patients.
- It is typically reserved for cases where ultrasound findings are equivocal or other diagnoses are strongly suspected, or when the patient is older or body habitus limits ultrasound utility.
*Abdominal CT scan with IV and PO contrast*
- Adding **oral contrast** to a CT scan significantly increases the time before imaging can be performed, which is not ideal in an acute emergency like suspected appendicitis.
- While it can help delineate bowel loops, the additional contrast and associated delay are usually **unnecessary** for diagnosing appendicitis and further expose the child to radiation.
Fever of unknown origin approach US Medical PG Question 10: A 4-year-old boy who otherwise has no significant past medical history presents to the pediatric clinic accompanied by his father for a 2-day history of high fever, sore throat, nausea, vomiting, and bloody diarrhea. The patient’s father endorses that these symptoms began approximately 3 weeks after the family got a new dog. His father also states that several other children at the patient’s preschool have been sick with similar symptoms. He denies any other recent changes to his diet or lifestyle. The patient's blood pressure is 123/81 mm Hg, pulse is 91/min, respiratory rate is 15/min, and temperature is 39.2°C (102.5°F). Which of the following is the most likely cause for this patient’s presentation?
- A. Exposure to bacteria at school (Correct Answer)
- B. A recent antibiotic prescription
- C. Reheated fried rice
- D. The new dog
- E. Failure to appropriately immunize the patient
Fever of unknown origin approach Explanation: ***Exposure to bacteria at school***
- The combination of **bloody diarrhea**, high fever, vomiting, and **similar symptoms in other children at preschool** strongly suggests an outbreak of bacterial gastroenteritis, with **Shiga toxin-producing *E. coli* (STEC)** often implicated in such settings.
- This scenario points to a **common source of infection** within the preschool environment, facilitating person-to-person transmission or exposure to contaminated food/water.
*A recent antibiotic prescription*
- While antibiotics can cause diarrhea, especially **Clostridioides difficile (C. diff)**, the absence of prior antibiotic use in this patient weakens this possibility.
- Antibiotic-associated diarrhea typically does not spread to multiple children in a preschool unless there is a common source of toxin or organism.
*Reheated fried rice*
- **Reheated fried rice** is primarily associated with **Bacillus cereus** food poisoning, which typically causes rapid onset vomiting or diarrhea without a prolonged incubation period.
- This type of food poisoning is less likely to result in bloody diarrhea or widespread outbreaks in a preschool.
*The new dog*
- **Zoonotic infections** from dogs, such as **Campylobacter** or **Salmonella**, can cause similar symptoms but typically have a shorter incubation period than 3 weeks.
- The **widespread illness** at preschool makes exposure within the school a more likely primary cause for the outbreak.
*Failure to appropriately immunize the patient*
- While vaccinations prevent many infectious diseases, **no routine vaccine** specifically prevents the common bacterial causes of bloody diarrhea outbreaks in this age group, such as **Shiga toxin-producing *E. coli***.
- Immunization status is generally not directly linked to a sudden outbreak of infectious gastroenteritis of this specific type.
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